This document discusses various methods used to investigate cardiac diseases, including electrocardiography (ECG), chest x-rays, echocardiography, ambulatory ECG monitoring, radionuclide scanning, cardiac catheterization, and coronary angiography. It provides details on what each test can detect, such as arrhythmias, conduction defects, or enlarged heart chambers. Echocardiography is highlighted as a sensitive method for evaluating heart chamber size and function, including ejection fraction and wall motion. Different echocardiography techniques including 2D, M-Mode, and Doppler are described for assessing abnormalities.

1. Investigation in cardiac
diseases
CVS

2. Methods
 ECG(electrocardiograph)
 Chest X-rays
 Echocardiograph
 Ambulatory ECG
 Thallium 201 scanning (radionuclide scanning)
 Technetium-99-labeled sestamibi (radionuclide scanning)
 Cardiac catheterization
 Coronary angiography

3. ECG
 Ecg is useful to detect the following abnormalities
 Cardiac arrhythmia
 Conduction defects
 Myocardial infarction or ischemia
 Myocardia hypotrophy
 Electrolyte imbalance
 Toxicity of certain drugs

4. X-rays
 Heart size can be measured only from PA view of chest x-rays because in AP
view cardiac shadow is large.
 The maximum transverse diameter of the heart is compared with the
maximum transvers diameter of the chest is measured from inside of the ribs,
this is called cardiothoracic ratio (CTR)
 It should be less than 50 %.
 Cardiomegaly and pericardial effusion cause an increase in cardiothoracic
ratio.

5. X-rays
 Pericardial effusion
produce globular
shadow

6. X-rays
 Left atrial dilatation manifests as prominence of left atrial appendage on the
left heart border and a double atrial shadow to the right of the sternum
(double right border)

7. X-rays
 Left ventricular enlargement manifests as increased CTR and increased
convexity of the left heart border.

8. X-rays
 Right atrial enlargement manifests as projection of right border of heart into
the right lower lung field

9. X-rays
 Right ventricular enlargement manifests as CTR and an upward displacement
of the apex of the heart.

10. X-rays
 Enlargement of pulmonary artery manifests as a prominent bulge on the left
heart border below the aortic knuckle.

11. X-rays
 Lung field may indicate pulmonary hypertension by enlargement of the hilar
vessels
 Enlarged right lower lob artery
 Kerly’s B lines and pleural effusion may be present in cardiac failure

12. Echocardiograph
 It is sensitive method to determination of
 Size of all four chambers of heart

13. Echocardiograph
 Left ventricular function (ejection fraction)

14. Echocardiography
 Regional wall motion abnormalities due to myocardial infarction
 Complication of myocardial infarction such as papillary muscles dysfunction
mitral regurgitation
 Structural valve abnormalities stenosis and regurgitation
 Cardiac output
 Ventricular hypertrophy
 Pericardial effusion
 Atrial and ventricular septic defects and other congenital defects.

15. Types of echocardiography
 Two-dimensional real time echocardiography
 M-mod echocardiograph
 Doppler echocardiograph

16. Two-dimensional real time
echocardiograph
 Detecting wall motion abnormalities
 Intracardiac masses
 Thrombi and tumors
 Endocarditic vegetations
 Congenital heart disease

17. M-mod echocardiography
 Measurement of size of chambers of heart
 Calculation of ejection fraction and accurate timing of cardiac events

18. Doppler echocardiograph
 Abnormal direction of blood flow
 Aortic mitral or mitral regurgitation
 Pulse-wave Doppler (PW)
 Continuous-wave Doppler (CW)
 Color doppler